Fetal alcohol spectrum disorders (FASD) are thought to be the most common developmental disabilities worldwide, and one of the few developmental disorders that are known to be completely preventable. While much research has focused on the dysmorphological and neurological features of fetal alcohol spectrum disorders (FASD), there is a critical gap in the literature with regard to our understanding of the nutritional and immunological mechanisms whereby postnatal growth and performance deficits in children affected by alcohol are initiated and subsequently persist throughout childhood, and therefore might be targets for postnatal intervention. Based on preliminary data from an ongoing clinical trial in Ukraine, conducted in a sample of moderate to heavy alcohol-consuming pregnant women, a multimicronutrient supplementation (multiple-vitamin-mineral supplement with or without additional choline) given during pregnancy is associated with a marked reduction of alcohol-related growth and neurocognitive deficits in infants at 6 and 12 months of age. These promising initial findings could have worldwide public health impact if demonstrated to persist. The primary goal of the current application is to investigate the persistence of the beneficial effects of multimicronutrient supplementation on growth and development through preschool age in an established longitudinal sample of children in Ukraine. Secondary goals of this application are to evaluate postnatal factors, including nutritional status of the child and marker of immune function and oxidative stress, that may contribute to persistent deficits among alcohol-exposed children in the context of prenatal nutritional factors. The proposed study will build on the strengths of an established Ukrainian cohort of well- characterized children, now between 2 and 5 years of age: a) to assess the impact of known prenatal alcohol exposure, with or without a past prenatal nutritional intervention, on the child's growth and neurobehavioral function through 5 years of age, and b) to determine the antecedents of an alcohol-affected child's postnatal nutritional and immunologic status and the contribution of this postnatal environment to persistent neurobehavioral and growth deficits. PUBLIC HEALTH RELEVANCE: Fetal alcohol spectrum disorders (FASD) are thought to be the most common developmental disabilities worldwide. The goal of this study is to investigate the beneficial effects of prenatal vitamin supplements on growth and development of alcohol-exposed children through preschool age, and to examine the role of childhood nutrition in the growth and learning deficits seen in FASD. Findings of this study will help inform potential interventions for children with this disorder.